Reauthorization Specialist

Location: Remote, PA

Cardiac Management Solutions

The Cardiac Management Solutions division of ZOLL Medical Corporation develops products to protect and manage cardiac patients, including the LifeVest® wearable cardioverter defibrillator (WCD), the ZOLL cardiac monitor, and associated technologies. Heart disease is the leading cause of death for both men and women in the U.S. At ZOLL, your work will help to ensure cardiac patients get the life-saving therapy they need. To date, the LifeVest WCD has been worn by hundreds of thousands of patients and saved thousands of lives. ZOLL has been Pittsburgh’s Manufacturer of the Year, one of Western PA’s Healthiest Employers, and even one of Pittsburgh’s Coolest Offices. But it’s our unique opportunity to impact people’s lives that makes ZOLL the ideal place to build your career.

Job purpose

The Reauthorization Specialist is an integral member of the reimbursement team and has primary responsibility for the timely initiation of reauthorizations with insurance carriers for established patients. The representative will also be in contact with the physician office and sales staff for additional clinical information, progress notes and additional testing when required. 

Duties and responsibilities

  • Communicates medical need and educates case manager on LifeVest system to obtain authorization for services. Works with insurance carriers to authorize service for existing patients.
  • Negotiates favorable rates with insurance carriers to guarantee assignment of benefits and determine appropriate fee schedules for the billing process.
  • Obtains necessary documentation for continued authorization as dictated by payer, including updated clinical information or forms.
  • Contacts the client, physician office and sales representative to relay or obtain pertinent information and documentation to ensure continued coverage.
  • Completes weekly follow up with physicians or sales team to obtain updated clinical for existing patients. Interacts with sales staff as needed to obtain required documentation.
  • Responsible for generation of all reauthorization requests based on initial expiration.
  • Performs other duties as assigned by Management.

Qualifications

Qualifications include:

H.S. Diploma or equivalent required.  Superior communication and customer service skills, and ability to handle multiple tasks simultaneously under strict deadlines. 

  • H.S. Diploma or equivalent required.
  • 3-5 years’ experience in medical insurance verification recommended
  • Strong negotiation skills.
  • Experience working with all payer types to include Medicare, Medicaid and third-party commercial insurance companies.
  • Superior communication, customer service skills and strong phone presence.
  • Ability to handle multiple tasks simultaneously under strict deadlines.
  • Proficiency in MS Excel, email programs and online data systems.

Working conditions

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 The noise level in the work environment is usually quiet.

Physical requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.

Supervisory responsibility

None

AAP/EEO Statement

ZOLL is committed to fostering an inclusive workplace, where unique identities, backgrounds, cultures, perspectives and experiences are respected and valued.

 Equal Opportunity Employer – Disability and Veteran

ZOLL now mandates COVID vaccinations subject to legal exemptions.

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